title: Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis.
abstract: BACKGROUND
  Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry.
  
  
  METHODS
  Adherence with these medications in eligible patients at baseline and 1-year follow-up was assessed. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 4 years.
  
  
  RESULTS
  A total of 37,154 patients with established atherothrombotic disease were included. Adherence rates with all evidence-based medications at baseline and 1 year were 46.7% and 48.2%, respectively. Nonadherence with any medication at baseline (hazard ratio, 1.18; 95% confidence interval, 1.11-1.25) and at 1 year (hazard ratio, 1.19; 95% confidence interval, 1.11-1.28) were both significantly associated with an increased risk of the primary end point. The risk of all-cause mortality was similarly elevated. Corresponding numbers needed to treat were 31 and 25 patients for the composite end point and total mortality, respectively. This also was true for each disease-specific subgroup. Patients who were fully adherent at both time points had the lowest incidence of adverse outcomes, whereas patients who were nonadherent at both time points had the worst outcomes (P < .01).
  
  
  CONCLUSIONS
  Our analysis of a large international registry demonstrates that nonadherence with evidence-based secondary prevention therapies in patients with established atherothrombosis is associated with a significant increase in long-term adverse events, including mortality.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Elaine
authors.initials: E
authors.lastname: Hoffman
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Atherosclerosis; Cardiovascular disease; Compliance/adherence; Registry; Secondary prevention